SRH Hayward Town Hall

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					        St Rose Hospital Town Hall


         Safety Hospital Strategy, Summer 2012




The data shown here reflects only Alameda County residents who visited these facilities. Utilization will be lower
                         than what a facility reports to the state on total patient volume.

    Kaiser Fremont is not reported by OSHPD as a licensed facility so they are combined with Kaiser Hayward
                                   Alameda County
                                     Health Care
                                   Services Agency

St Rose Hospital is an             The County has provided significant support to St Rose
Independent Disproportionate       Hospital over many years, including more than 40 million in
Share Hospital in Hayward.         the last five years of general operating subsidies.

                                   Multiple Health System Partners have also supported
                                   St Rose , Specifically through the creation of the St
St Rose is a critical safety       Rose Emergency Fund (7 million, established 2009)
net provider of general acute      and 12.5 million in stabilization funding over the last 8
                                   months.
care for central and southern
Alameda County.                    St Rose’s Fiscal and Operational Challenges have been
                                   well documented and discussed by The Alameda County
  30,0000 ED Visits
                                   Board of Supervisors at multiple Health Committee
  15% of indigent Inpatient Care   presentations, and in recent actions by the BOS and
  40% MediCal Inpatient            other health system stakeholders.
                   The Problem
• There is simply not now, nor will there be in the foreseeable
  future, an adequate supply of Primary and Preventative Care.

• Health Care costs are rising at five times the rate of wages,
  with health care premiums doubling in the last decade and
  projected to at least double in the next decade.

• A significant part of the problem is that we continue to drive
  episodic care to the highest cost settings.

• The General Acute Care system in Alameda County relies on
  public sector subsidies for the handful of safety net hospitals
  that serve he majority of the under and uninsured.
             The Problem (cont.)
• Per the American College of Emergency Room
  Physicians, California ranks 51st among states in the US
  in terms of ED capacity.

• In all other jurisdictions that expanded coverage
  (Vermont and Massachusetts), there were significant
  increases in ED utilization after coverage expansion.

• Safety net providers, particularly general acute care
  providers have to look at competition in a post reform
  health care economy.

• Safety net hospitals must forge new alliances and
  converge their operating models to leverage
  supplemental payments, and operating efficiencies.
                             ACMC                                                71,291


                     Kaiser Hayward                                             68,388


Emergency                Washington                              45,169
Department
Visits:               Kaiser Oakland                            43,350


                          Children's
Alameda County
                                                              38,074



Acute Care         ABSMC-Hawthorne                           36,124

Facilities, 2010            St. Rose                    32,804


(N=457,582)                    Eden                    30,765


                         ABSMC-AB                      30,440


                        San Leandro                 24,730


                          Valleycare            23,497


                           Alameda         12,950


                                       0   20,000      40,000          60,000    80,000

                                              Number Visits
                         ACMC                                             66.5


                       Alameda                                35.2


Emergency               St. Rose                       24.5


Department   Total AC Acute Care                       23.5


Visits:                    Eden                     19.9


             ABSMC-Hawthorne                        19.6

Estimated
Percentage
                     ABSMC-AB                   17.5




Uninsured
                     Washington                 17.3


                    San Leandro                 16.3



2010                  Valleycare              14.1


                      Children's             11.7


                 Kaiser Oakland         8.6


                 Kaiser Hayward        6.6


                                   0           20             40     60          80
                                                     Percentage
        Emergency Department Payer Source:
     Alameda County Acute Care Facilities, 2010

       Children's


         St. Rose


      Washington


ABSMC-Hawthorne


      ABSMC-AB


            Eden


           ACMC


       Valleycare


     San Leandro


        Alameda


  Kaiser Hayward


   Kaiser Oakland

                    0%     10%     20%     30%        40%       50%    60%       70%       80%    90%       100%
                         MediCal    NonFed/Indigent         Self-Pay   Private         Other     Medicare
Who Goes Where?

  The Affordable Care Act Will Add More Than 200,000
   Covered Individuals in Alameda County
                                                                          Employer and
MediCaid Expansion                  The Exchange                          Individual Mandate



    0% FPL                      133% FPL                                   400% FPL

        56,000 newly eligible              107,000 eligible for subsidy        35,000 required to
                                                                               purchase or their
                                                                               employer will be required
                                                                               to purchase
             Approximately 60,000 Alameda County Residents
             will not be insured, even under the most optimistic
             implementation scenario
                                ACMC                                                      26.2


                               St. Rose                           8.6


                    Total AC Acute Care                     5.9


Inpatient Visits:                 Eden                      5.5


Estimated                  San Leandro                     5.4

Percentage                    Alameda                     4.3

Uninsured 2010      ABSMC-Hawthorne                   4.0


                            Washington               3.2


                            ABSMC-AB                2.5


                             Valleycare         2.4


                        Kaiser Oakland         1.7


                        Kaiser Hayward        1.3


                             Children's       0.8


                                          0                       10                 20      30
                                                                        Percentage
            Inpatient Visit Payer Source:
      Alameda County Acute Care Facilities, 2010
           ACMC


       Children's


         St. Rose


      ABSMC-AB


            Eden


       Valleycare


     San Leandro


ABSMC-Hawthorne


        Alameda


      Washington


  Kaiser Hayward


   Kaiser Oakland

                    0%    10%       20%        30%   40%        50%     60%     70%       80%     90%      100%
                         Medi-Cal         Indigent   Self-Pay         Private     Other         Medicare
                                                  ED Overload & Critical Patient Overload

                                  500
                                  450                                                   434
Number of Diversion Occurrences




                                  400
                                  350
                                  300
                                                                                                             ED
                                  250                         224
                                                                                                             CPO
                                  200                                             175
                                                        144                 137
                                  150
                                  100                                                         87
                                                                                                   55
                                  50         39
                                        14          6               5   3                               12
                                   0
Summit
                       Highland


         San Leandro
                                  Eden
               St. Rose
 >30%
  20 - 29.9%
  10 - 19.9%
                >1.5% CR       (48 – 72 visits)
                 1 – 1.5% CR   (32 – 48 visits)




County Rate (CR) = 32.08 ED visits / 100 persons
                       > 1.5 times the CR (6-10.5 avoidable visits/100)
                       > 1-1.5 times the CR (4-6 avoidable visit/100 )




County Rate (CR) = 4 avoidable ED visits / 100 people
                   Take Away
• Safety Net Hospital face real and significant revenue
  challenges.

• The loss of additional general acute care facilities and
  their 911 receiving centers will comprise our county’s
  health care delivery system, in particular those
  communities with the most serious access shortages.

• Safety Net Hospitals, particularly the designated public
  and non designate public systems, must seek new
  and converged operating structures to promote
  efficiencies and leverage supplemental payment
  mechanisms.
     Current Status of Safety Net
        Partnership Strategy
• Children’s Hospital and Research Center
  Oakland (CHRCO) and UCSF have signalled
  intent to merge.
• Alameda Hospital has secured licensing for
  SNF: long term affiliation potential still unclear.
• SLH Hospital in Negotiations with Eden, Sutter,
  and ACMC
• SRH in Negotiations with ACMC and Private
  Operator
• ACMC ATR on Schedule, short term revenue
  picture strong.
                        Alameda County
                      Health Care Services
                            Agency
Three Time Lines:


1) Where we have been: February to August 2012 (now)




2) Where we are going in the short term: August 2012 to
   January 2013 (next six months)



3) Where we are going over the next 18 months: January 2013
   to February 2014 (18 months and ongoing)
                                       Alameda County
                                     Health Care Services
                                           Agency
Stabilization Period Partners: 3/1/12 to 7/30/12
Washington Township Hospital District: 2 million (1 million match secured)

Cal Mortgage Bond Fund: 2 million (Began 2/28 at 350k a month)

Alameda County Board of Supervisors: 2 million (1 million match secured)

Managed Care Contract Enhancements : 2 million (secured)

CMAC Distressed Hospital Fund: 2.25 million (secured)

Kaiser Community Benefit Program: (3.5 million still under consideration)

TOTAL: 12.25 Million            (3.5 million plus 1.75 million match pending)


CMAC Insured Line of Credit: 4 million

Note: 7.5 million of the above commitments are eligible for federal matching funds
via Intergovernmental Transfer. Will generate and additional 3.75 in FFP, bringing
total to 17.5 million.
                                                            St Rose Hospital Transitional
                                                                     Authority                                                   August 2012
FEBRUARY 2012
                 2/28 Cal
                                                3/22
 2/7 BOS        Mortgage                                                         To 7/30/12 JPA Meeting
                                               CMAC
Approves        Approves
                                              Approves
 funding         2 million
                                                2.25
 for CTO        bond fund
                                               Million
                  release
    2/22 LOI                                           4/24 AC BOS
                            3/13 AC BOS                                      Stabilization and Evaluation
   Executed:                                          Approves JPA
                             Considers                                    180 days or less for WTHD to complete fiscal and
     WTHD
                          Negotiations and                                           operational due diligence.
   Approves 2
                         approves 2 million
     Million



       Initial Agreements and                                        Price Waterhouse
                                                                                                                      Ongoing Operations
           Letters of Intent                                            Assessment


                                                                Ongoing Operations:
                                                                The purpose of an agreement for the county could be:
           Emergency Infusion                                   - Secure and Distribute Funding for St. Rose
              LOC for 4 million    3/16 MC                                                                                       Kaiser
                                  Contract                      - Conduct due diligence for WTHD                               Considers
                                  Enhanced                      - Consider and provide input on possible operating             3.5 Million
                                                                structures for SRH moving forward.
            Lender Requires:
            -Change in Management                                           Management Arrangement
            -Funding Commitments                         Arrangements may be made by SRH for a assistance in Management
            -County Negotiations Opened                             during the Stabilization and Evaluation Period


Notes:
                                                                                     Implementation
                                                                                       Time Line
                                                         St Rose Hospital Transitional
                                                                  Authority                                                      January 2013
August 2012
                        SRH Board
                                              HCSA
  PWC                     Opens                                              Short Term Operations and
                                             Secures
 Report                Negotiations
Reviewed               w ACMC and
                                               1115                            Funding Requirements
                                              Waiver
                          Private
                                             Funding
                         Operator
        WTHD                                 by 9/30
    Releases SRH                                                               Partnership Evaluation
      from LOI                                                          Evaluate Partnership Opportunities with Public and
                                                                                        Private operators



                          Explore New Partnership                             Reimbursable Advance
    Gap Analysis                                                                                                      Ongoing Operations
                               Opportunities




           Short Term Funding                             Kaiser or                                                    Secured
             Requirements                                   Other                                                       IGT by
                                                          Approves                                                       12/31
           3 million by 9/30 (HCSA)                       3.5 Million

      3 million by 12/31 (System + IGT)
                                                                         Management Arrangement
                                                       Arrangements may be made by SRH for a assistance in Management
                                                                    during the Partnership Evaluation Period


Notes:                           SRH Continues
                          Implementation of HFS Study                               Implementation
                            and SRH Turnaround Plan                                   Time Line
                                                            St Rose Hospital Transitional
                                                                     Authority                                                   February
 January 2013
                                                                                                                                 2014
                           Continued
                                                 Secure
  Parcel               Implementation of                                   Long Term Funding Picture
                                               Additional
 Measure                Turnaround Plan
                                                ongoing
Feasibility                (operating
                                                 Public
                        efficiencies and
                                                Subsidy
                            Revenue)
        Initiate CSA
                                                                             Secure Parcel Measure
                                                                      Evaluate Partnership Opportunities with Public and
                                                                                      Private operators



                             Explore New Partnership             Reimbursable Advance
      Gap Analysis                                                                                                  Ongoing Operations
                                  Opportunities




              Long Term Funding                                         Sources of Ongoing Support
                Requirements:
                                                        Parcel Measure or SNCP                                   (4 million)
              10 million annualized by                  Public Subsidy Enhanced                                  (1 million)
                   February 2014
                                                        IGT                                                      (2.5 million)
                                                        Operating Efficiencies                                   (1.0 million)
                                                        Revenue Enhancement (volume/contracts)                   (1.5 million)

                                                                                                         TOTAL: 10 Million

 Notes: SRH Gap analysis 8-12 million
                                                                               Implementation
                                                                                 Time Line

				
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posted:9/13/2012
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